Background The aging population of the UK is associated with rising health and social care spending. The need for sustainable provision of end-of-life care is therefore a public health priority, with successive governmental strategies aiming to reduce the proportion of people dying in hospital. Advance care planning (ACP) supports patients to make and communicate decisions about their end-of-life care preferences. Previous research indicates that this reduces intensive medical intervention and terminal hospital admissions, leading to decreased health service costs. However, this healthcare perspective disregards the likely redistribution of costs to other public services and unpaid carers, potentially overstating the cost effectiveness of ACP. This study uses a broader societal perspective to construct a decision tree to model the costs and benefits of ACP in comparison to No ACP, and critically evaluates the appropriateness of this model in end-of-life care.
Methods A decision tree was constructed consisting of three branches: participation in ACP, location of end-of-life care, and attainment of end-of-life care preferences. Values for each branch were obtained using targeted literature searching, adjustment for inflation, and assumptions based on best estimates from an expert panel. Sensitivity analysis was performed to evaluate the impact of uncertainty on the model.
Results All decisions resulted in a net cost for end-of-life care, which was not outweighed by the included benefits. However, ACP was the optimal economic decision, with a net cost of -£3,602 compared with -£4,000 for No ACP. The model was sensitive to changes in the value of informal care and the value of achieving end-of-life care preferences.
Conclusion The optimal economic decision in this study supports the upscaling of ACP in the UK. This is in keeping with previous research indicating that ACP is likely to be cost-effective, and supports the economic rationale for the current UK end-of-life care strategy. However, this should be approached sensitively, and with the understanding that the principal aim of ACP is to support patient autonomy and welfare, rather than to save money. The optimal economic decision regarding ACP is sensitive to changes in several uncertain variables. Further research is therefore required regarding the social value of informal care in the UK, and exploration of the economic value of a ‘good death’ as a costable benefit.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.